Histologic and oncologic outcomes following liver mass resection with retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumor Journal Article


Authors: Pietzak, E. J.; Assel, M.; Becerra, M. F.; Tennenbaum, D.; Feldman, D. R.; Bajorin, D. F.; Motzer, R. J.; Bosl, G. J.; Carver, B. S.; Sjoberg, D. D.; Sheinfeld, J.
Article Title: Histologic and oncologic outcomes following liver mass resection with retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumor
Abstract: Objective: To evaluate the oncologic outcomes and histologic concordance of postchemotherapy residual liver mass resection with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Methods: Retrospective review of our prospectively maintained germ cell tumor (GCT) surgical database identified patients with nonseminomatous GCT who underwent both postchemotherapy residual liver mass resection and PC-RPLND between 1990 and 2015. Results: A total of 36 patients were identified, of whom 29 (81%) presented with a liver mass at initial diagnosis and 17 (47%) received second-line chemotherapy before liver resection. Teratoma was found in 8 (22%) and 5 (14%) of PC-RPLND and liver resection specimens, respectively. Viable GCT was found in 5 (14%) and 4 (11%) of PC-RPLND and liver resection specimens, respectively. Histologic discordance was observed in 4 of 19 patients (21%; 95% confidence interval [CI] 6.1%-46%); in all cases, liver resection specimens contained teratoma or viable GCT while PC-RPLND revealed only fibrosis or necrosis. At 3 years after surgical intervention, the Kaplan-Meier estimated probability of cancer-specific survival was 75% (95% CI 55%-85%) and the probability of progression-free survival was 75% (95% CI 56%-87%). Conclusion: In this contemporary cohort, clinically significant discordance was observed between the histology of metastatic liver masses and that of retroperitoneal lymph nodes. The benefit of postchemotherapy liver mass resection for patients with advanced nonseminomatous GCT is supported by favorable survival outcomes. Until more reliable predictors of postchemotherapy histology exist, complete surgical resection of all sites of residual disease should be performed whenever feasible. © 2018 Elsevier Inc.
Keywords: adult; cancer chemotherapy; clinical article; human tissue; treatment outcome; surgical technique; cisplatin; paclitaxel; drug megadose; lymph node dissection; prospective study; carboplatin; progression free survival; etoposide; cohort analysis; retrospective study; histology; ifosfamide; patient identification; liver metastasis; cancer specific survival; liver tumor; bleomycin; liver resection; non seminomatous germinoma; human; priority journal; article
Journal Title: Urology
Volume: 118
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2018-08-01
Start Page: 114
End Page: 118
Language: English
DOI: 10.1016/j.urology.2018.04.009
PROVIDER: scopus
PUBMED: 29704586
DOI/URL:
Notes: Article -- Export Date: 4 September 2018 -- Source: Scopus
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MSK Authors
  1. Dean Bajorin
    404 Bajorin
  2. Robert Motzer
    744 Motzer
  3. Darren Richard Feldman
    171 Feldman
  4. Joel Sheinfeld
    195 Sheinfeld
  5. Daniel D. Sjoberg
    138 Sjoberg
  6. Brett Stewart Carver
    109 Carver
  7. George Bosl
    255 Bosl
  8. Melissa Jean Assel
    38 Assel
  9. Eugene J Pietzak
    19 Pietzak
  10. Maria Fernanda   Becerra
    15 Becerra